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Should You Worry About Sexually Transmitted Infections?

Older lovers are at lower risk — but not zero risk

En español | Should sexually transmitted infections (STIs) concern older singles?

If so, can condom use prevent the spread of STIs?

Most people age 45-plus are apparently saying "No" to both questions.

See also: 50 things that are better than sex

When AARP surveyed singles 45 and older in 2009, for example, only 1 in 5 reported using condoms every time. The gender breakdown was dramatic: 32 percent of the women, 12 percent of the men. That means most older singles believe they don't run a significant risk of contracting syphilisgonorrheachlamydia, herpes, genital warts or HIV

Multi-colored condoms, STI protection for people 45+

Sexually transmitted infections are on the rise among older, single adults, but condom use is lagging behind. — Istockphoto

And they're right. Almost.

STIs are by far most prevalent among those under 30. Among 20-somethings, syphilis infects 20 men and four women per 100,000. For those in their 50s, by contrast, syphilis infects only five men and 0.5 women. (Still, it's the STI most prevalent in people 45 and older.)

When compared with young adults, an older man's risk of getting gonorrhea or chlamydia is 95 percent lower; an older woman's is 99 percent lower.

Older singles also neglect condoms because they're less likely to have sex involving the main route of STI transmission: vaginal intercourse.

The (not necessarily sad) truth is that intercourse often fades from the erotic repertoire with age. Erectile medications are less effective than advertised, while menopausal changes can make intercourse uncomfortable or impossible, even with a lubricant. As a result, older couples adapt to sex without intercourse: hand massage, oral sex and sex toys.

Gonorrhea can infect the throat, and herpes often shows up as cold sores on the lips. Most other STIs, however, are rarely transmissible orally. So it's logical, I suppose, for older daters who make love without intercourse to conclude they don't need condoms.

Or do they?

Public-health authorities insist they do. As 50 becomes the new 30, older adults' STI rates have risen. Since 2005, their risk of syphilis has jumped 67 percent and chlamydia 40 percent. No wonder health experts recommend consistent condom use for anyone who dates — until, that is, both partners have pledged monogamy and have tested STI-free.

At 63 I'm married and monogamous, but here's how I would approach the issue if I were single: Before jumping into bed with my newest hot friend, I'd try to get to know her over several dates first. I would ask her, gently but directly, about her sexual history; the more lovers she listed, the greater her (and therefore my) STI risk. I'd also lay out my history with illicit drugs, and probe hers.

Here's why: The vast majority of heterosexuals infected with HIV have a history of IV drug use. And people reckless enough to abuse opiates, cocaine or methamphetamine are often sexually reckless too.

New friends might lie about their STI risk, of course, so I'd carry condoms just in case. And, if we had intercourse, I'd insist on using them.

This may not sound very romantic, I know, but you can always make a date to get mutually tested. Many county health departments offer free STI testing. Then, if she's willing and you both test negative, can you think of a fitting way to celebrate?

But what happens if a prospective new partner declares herself infection-free and says testing isn't necessary? I'd still hold out for independent corroboration. One never knows.

And if she tests positive? Well, if she's being treated for anything other than HIV, I'd avoid vaginal intercourse (or use condoms) until she is cured. If she has HIV, talk to several doctors before becoming sexual with her — if indeed you ever do (not recommended).

If a potential new bedmate reveals a history of herpes, ask about the last eruption. If it happened more than five years ago, the immune system has probably suppressed the infection and you can feel comfortable not using condoms.

Though small, STI risk for older singles is very real. So take Ronald Reagan's foreign policy to bed: "Trust but verify."

Michael Castleman answers sex questions for free at GreatSexAfter40.com.

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